Dramatic changes in the medical marketplace have presented large-scale health care purchasers with new challenges and opportunities. With these shifts, large commercial employers increasingly now select and negotiate with health plans for their enrollees and assure that managed care organizations deliver appropriate and high quality care. Value based purchasing (VBP) is a term that is sometimes used to describe a broad array of efforts by health care purchasers to consider quality of care and access to care as well as costs in contracting. A central goal of value based purchasing efforts is the procurement of the best quality health care at the most attractive price. We propose a comprehensive group of interrelated efforts within a nationally representative sample of local health care markets to examine value based purchasing within the private commercial market and the impact of these practices on health plan management and performance. These efforts will include: a survey of senior managers responsible for health plan purchasing in the largest commercial firms (as determined by number of employees) in each of the markets; a survey of administrators in managed care organizations responsible for overseeing health plan efforts in quality management; analyses of data on health plan quality performance as measured by the Health Plan Employer Data and Information Set (HEDIS) and the Consumer Assessment of Health Plan Survey (CAHPS). This series of interrelated data collection and analyses efforts is directly responsive to the AHRQ initiative "Impact of Payment And Organization On Cost, Quality And Equity" (PA-01-125). The specific aims of this proposal are: (1) To describe the use of a variety of value based purchasing strategies by purchasers of health care services in a national sample of forty markets. (2) To describe quality management practices of health plans that serve the commercial population in these same forty markets. (3) To examine the association between VBP activities (purchaser demands) and quality management practices by health plans. (4) To examine the association between the intensity of VBP activities and changes in quality performance as measured by HEDIS and CAHPS.